Seeger Harald, Kaelin Andrea, Ferraro Pietro M, Weber Damian, Jaeger Philippe, Ambuehl Patrice, Robertson William G, Unwin Robert, Wagner Carsten A, Mohebbi Nilufar
Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
Division of Nephrology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
BMC Nephrol. 2017 Dec 4;18(1):349. doi: 10.1186/s12882-017-0755-7.
Kidney stone disease is common in industrialized countries. Recently, it has attracted growing attention, because of its significant association with adverse renal outcomes, including end stage renal disease. Calcium-containing kidney stones are frequent with high recurrence rates. While hypercalciuria is a well-known risk factor, restricted intake of animal protein and sodium, combined with normal dietary calcium, has been shown to be more effective in stone prevention compared with a low-calcium diet. Notably, the average sodium intake in Switzerland is twice as high as the WHO recommendation, while the intake of milk and dairy products is low.
We retrospectively analyzed Swiss recurrent kidney stone formers (rKSF) to test the impact of a low-sodium in combination with a low-calcium diet on the urinary risk profile. In patients with recurrent calcium oxalate containing stones, we investigated both, the consequence of a low-sodium diet on urinary volume and calcium excretion, and the influence of a low-sodium low-calcium diet on urinary oxalate excretion.
Of the 169 patients with CaOx stones, 49 presented with hypercalciuria at baseline. The diet resulted in a highly significant reduction in 24-h urinary sodium and calcium excretion: from 201 ± 89 at baseline to 128 ± 88 mmol/d for sodium (p < 0.0001), and from 5.67 ± 3.01 to 4.06 ± 2.46 mmol/d (p < 0.0001) for calcium, respectively. Urine volume remained unchanged. Notably, no increase in oxalate excretion occurred on the restricted diet (0.39 ± 0.26 vs 0.39 ± 0.19 mmol/d, p = 0.277). Calculated Psf (probability of stone formation) values were only predictive for the risk of calcium phosphate stones.
A diet low in sodium and calcium in recurrent calcium oxalate stone formers resulted in a significant reduction of urinary calcium excretion, but no change in urine volume. In this population with apparently low intake of dairy products, calcium restriction does not necessarily result in increased urinary oxalate excretion. However, based on previous studies, we recommend a normal dietary calcium intake to avoid a potential increase in urinary oxalate excretion and unfavorable effects on bone metabolism in hypercalciuric KSFs.
肾结石疾病在工业化国家很常见。最近，它因与包括终末期肾病在内的不良肾脏结局有显著关联而受到越来越多的关注。含钙肾结石很常见且复发率高。虽然高钙尿症是一个众所周知的风险因素，但与低钙饮食相比，限制动物蛋白和钠的摄入，同时保持正常饮食中的钙摄入，在预防结石方面已被证明更有效。值得注意的是，瑞士的平均钠摄入量是世界卫生组织建议量的两倍，而牛奶和奶制品的摄入量较低。
我们对瑞士复发性肾结石患者（rKSF）进行回顾性分析，以测试低钠联合低钙饮食对尿液风险指标的影响。在患有复发性草酸钙结石的患者中，我们既研究了低钠饮食对尿量和钙排泄的影响，也研究了低钠低钙饮食对尿草酸排泄的影响。
在169例草酸钙结石患者中，49例在基线时存在高钙尿症。饮食导致24小时尿钠和钙排泄量显著降低：钠从基线时的201±89降至128±88 mmol/d（p<0.0001），钙从5.67±3.01降至4.06±2.46 mmol/d（p<0.0001）。尿量保持不变。值得注意的是，在限制饮食中草酸排泄量没有增加（0.39±0.26对0.39±0.19 mmol/d，p=0.277）。计算得出的Psf（结石形成概率）值仅对磷酸钙结石的风险有预测作用。
复发性草酸钙结石患者采用低钠低钙饮食可显著降低尿钙排泄，但尿量无变化。在这个奶制品摄入量明显较低的人群中，限制钙摄入不一定会导致尿草酸排泄增加。然而，基于先前的研究，我们建议保持正常饮食中的钙摄入量，以避免高钙尿性KSF患者尿草酸排泄潜在增加以及对骨代谢产生不利影响。
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